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Six Things I wish I knew before I started practice

Posted 12/15/2013

If done right a career in chiropractic will become increasingly rewarding with the passaging of each year.  The key to avoiding burnout is to continually challenge yourself to greater levels of knowledge and competencies.  As I mentor young chiropractors, I try to impart some of the knowledge that I have gained and some of the missteps that I have taken.  As I reflect on a three decade career, I would like to share six things that I wish that I had known when I started practice.

  1. The need to master the examination.  In college we all learned how to give an incredibly detailed examination that analyzed many aspects of a patient’s health. The only problem with it was that it took two to three hours to complete.  What we learned in chiropractic college was so detailed that it was impractical.  So impractical that most chiropractors never mastered the exam and stick to a very focused examination.  A few years ago I purposed to master the neuro/ortho/chiropractic examination.  I practiced and arranged the examination until I could perform a 148 point examination and document it in ten minutes.
  2. How to read MRI.  Of course when I graduated MRIs were not available, but as the years progressed I realized what a valuable tool these studies are.  When patients would bring their MRIs to my office I would muddle through reading them until I finally committed myself to learn to read MRI.  For years I went to morning report with our neurosurgery and neuroradiology departments until I learned how to read MR.
  3. There will be negative outcomes.  A great physician once told me after I strained a patient’s ribs with a side posture adjustment, “Bill if you don’t want any negative outcomes, don’t treat any patients.”  No healer ever wants to injure a patient, but it is unavoidable for every profession.  Much of being a good doctor is helping patients understand risk and striving to minimize patient risk.  Treating patients is what we do, and we must do it with confidence to attain the desired results.
  4. The need to confront patient behavior.  When I first started practice I was so concerned that patients would like me that I would not confront them on important issues.  Issues like smoking, obesity, diet, exercise, sleep deprivation, and other harmful lifestyle choices.  I now have no hesitations about confronting a patient’s behavior. That is not to say that I am unsympathetic to my patients, I confront them with love.  One of my student interns had difficulty confronting an obese patient over her weight.  I told the student to treat the number on the scale the same way that she would treat the numbers on a blood pressure cuff.   They are both  health indicator metrics that need to be addressed.
  5. How rewarding being a chiropractor would be.  I thought that being a chiropractor would be a great profession when I selected it as my chosen profession many years ago, but from this vantage I can honestly say it was far, far more rewarding than I ever thought it would be.  Saving lives and saving lifestyles is what we do every day.  I have heard from several physician patients, “You have the best job in this hospital.”   Every time I hear that phrase I am warmed by the knowledge of its truth.
  6. Being the top of your class at graduation does not ensure that you will be a top clinician 30 years later.  Becoming a master clinician is not a sprint, it is a marathon.  Your knowledge at graduation is a starting point, not an end point.  If you pursue lifelong learning and advancement you will continually improve and develop as a clinician and after many years, achieve clinical mastery.   I should note that I had no idea how hard it would be to stay abreast of the expanding body of knowledge in healthcare.  It takes a concerted effort to have a career of continual growth and development, but the alternative is mediocrity.

To state the obvious the average doctor is average.  To become a master clinician we all need to step out of our comfort zones and work at becoming the master of our chosen career, regardless of whether you feel inspired or not.  I love this quote from Chuck Close, “Inspiration is for amateurs. I just get to work.”

A professional does her work well, even when she does not feel like it.  Master clinicians are masters of their craft whether they feel inspired or not.  Inspiration is for amateurs.